淋巴细胞指标在新型冠状病毒肺炎诊治中的作用

doi:10.3877/cma.j.issn.2095-5820.2021.03.009

目前新型冠状病毒(SARS-CoV-2)在全球范围内的传播对世界公共健康构成了巨大威胁。SARS-CoV-2实验室检测对疾病的诊断和预防起着重要作用。本文通过文献检索和数据收集、归纳、分析，阐述实验室常用的淋巴细胞指标(如淋巴细胞计数LYMPH、淋巴细胞百分比LYMPH%、中性粒细胞和淋巴细胞的比值NLR、淋巴细胞亚群等)对新型冠状病毒感染辅助诊断、预后评估、疗效监测的作用，为新型冠状病毒肺炎(COVID-19)的治疗及预后判断提供参考依据。

关键词: 冠状病毒科, 淋巴细胞

At present, the global spread of novel coronavirus (SARS-CoV-2) has posed a great threat to world public health. SARS-CoV-2 laboratory testing plays an important role in the diagnosis and prevention of disease. Through literature retrieval, data collection, analysis and induction, the role of commonly used lymphocyte indicators was elaborated in auxiliary diagnosis, prognosis assessment and efficacy monitoring of novel coronavirus infection, so as to provide reference for the treatment, prevention and control of COVID-19.

Key words: Coronaviridae, Lymphocyte

表1 COVID-19患者白细胞各指标水平［M(P25，P75)］

项目	作者	总体	非重症	重症	P值
WBC×10⁹/L	Qin^［8］	5.3(3.9~7.5)	4.9(3.7~6.1)	5.6(4.3~8.4)	＜0.001
	He^［16］	4.75(3.98~5.94)	4.74(4.04~5.76)	4.84(3.83~7.85)	0.021
	Zhu^［17］	5.00(4.20~6.80)	5.00(4.30~6.50)	5.35(4.13~7.53)	0.568
NEUT×10⁹/L	Qin^［8］	3.9(2.6~5.8)	3.2(2.1~4.4)	4.3(2.9~7.0)	＜0.001
	Liu^［18］	3.6(2.5~6.4)	3.1 (2.2~4.4)	6.7 (3.9~10.5)	＜0.001
	Zhu^［17］	3.37(2.54~4.55)	3.29(2.54~4.40)	3.89(2.25~6.57)	0.309
LYMPH×10⁹/L	Qin^［8］	0.9(0.6~1.2)	1.0(0.7~1.3)	0.8(0.6~1.1)	＜0.001
	Liu^［18］	0.97(0.65~1.42)	1.17(0.89~1.58)	0.60(0.38~0.76)	＜0.001
	Zhu^［17］	1.21(0.87~1.48)	1.23(0.90~1.53)	0.74(0.47~1.18)	0.004
NLR	Qin^［8］	4.2(2.5~7.7)	3.2(1.8~4.9)	5.5(3.3~10.0)	＜0.001
	Liu^［18］	3.6 (2.0~9.7)	2.6 (1.7~4.5)	10.4 (7.2~21.3)	＜0.001
	Zhu^［17］	2.91(1.95~4.15)	2.75(1.90~3.95)	4.24(3.00~10.87)	0.015

表1 COVID-19患者白细胞各指标水平［M(P25，P75)］

项目	作者	总体	非重症	重症	P值
WBC×10⁹/L	Qin^［8］	5.3(3.9~7.5)	4.9(3.7~6.1)	5.6(4.3~8.4)	＜0.001
	He^［16］	4.75(3.98~5.94)	4.74(4.04~5.76)	4.84(3.83~7.85)	0.021
	Zhu^［17］	5.00(4.20~6.80)	5.00(4.30~6.50)	5.35(4.13~7.53)	0.568
NEUT×10⁹/L	Qin^［8］	3.9(2.6~5.8)	3.2(2.1~4.4)	4.3(2.9~7.0)	＜0.001
	Liu^［18］	3.6(2.5~6.4)	3.1 (2.2~4.4)	6.7 (3.9~10.5)	＜0.001
	Zhu^［17］	3.37(2.54~4.55)	3.29(2.54~4.40)	3.89(2.25~6.57)	0.309
LYMPH×10⁹/L	Qin^［8］	0.9(0.6~1.2)	1.0(0.7~1.3)	0.8(0.6~1.1)	＜0.001
	Liu^［18］	0.97(0.65~1.42)	1.17(0.89~1.58)	0.60(0.38~0.76)	＜0.001
	Zhu^［17］	1.21(0.87~1.48)	1.23(0.90~1.53)	0.74(0.47~1.18)	0.004
NLR	Qin^［8］	4.2(2.5~7.7)	3.2(1.8~4.9)	5.5(3.3~10.0)	＜0.001
	Liu^［18］	3.6 (2.0~9.7)	2.6 (1.7~4.5)	10.4 (7.2~21.3)	＜0.001
	Zhu^［17］	2.91(1.95~4.15)	2.75(1.90~3.95)	4.24(3.00~10.87)	0.015

图1 重症和非重症COVID-19患者淋巴细胞降低百分比

图2 不同NLR值COVID-19患者存活和死亡百分比

表2 COVID-19患者淋巴细胞亚群水平［M(P25，P75)］

指标	作者	总体	非重症	重症	P值
CD3⁺/L	He^［16］	801 (496~1154)	1 066(804~1321)	305(198~525)	＜0.001
	Kong^［20］	700(400~1000)	900(600~1300)	500(300~700)	＜0.001
CD4⁺/L	He^［16］	461 (269~701)	645 (461~794)	184(103~293)	＜0.001
	Kong^［20］	400(200~600)	500(300~800)	200(100~400)	＜0.001
CD8⁺/L	He^［16］	291 (164~424)	366 (274~482)	121 (54~197)	＜0.001
	Kong^［20］	200(100~400)	300(200~500)	200(100~300)	＜0.001
CD4⁺/CD8⁺	He^［16］	1.66(1.27~2.20)	1.66 (1.37~2.16)	1.57(1.10~2.36)	0.342
	Kong^［20］	1.8(0.9~2.9)	0.2 (1~1.1)	1.5 (0.7-2.3)	0.030
CD19⁺/L	He^［16］	155 (105~229)	190 (139~268)	91 (54~139)	＜0.001
	Kong^［20］	100(100~200)	100(100~200)	100(50~100)	0.082
CD16⁺CD56⁺/L	He^［16］	127 (81~209)	144 (93~231)	105 (66~168)	＜0.001
	Kong^［20］	100(100~200)	200(100~300)	100(100~200)	0.074

表2 COVID-19患者淋巴细胞亚群水平［M(P25，P75)］

指标	作者	总体	非重症	重症	P值
CD3⁺/L	He^［16］	801 (496~1154)	1 066(804~1321)	305(198~525)	＜0.001
	Kong^［20］	700(400~1000)	900(600~1300)	500(300~700)	＜0.001
CD4⁺/L	He^［16］	461 (269~701)	645 (461~794)	184(103~293)	＜0.001
	Kong^［20］	400(200~600)	500(300~800)	200(100~400)	＜0.001
CD8⁺/L	He^［16］	291 (164~424)	366 (274~482)	121 (54~197)	＜0.001
	Kong^［20］	200(100~400)	300(200~500)	200(100~300)	＜0.001
CD4⁺/CD8⁺	He^［16］	1.66(1.27~2.20)	1.66 (1.37~2.16)	1.57(1.10~2.36)	0.342
	Kong^［20］	1.8(0.9~2.9)	0.2 (1~1.1)	1.5 (0.7-2.3)	0.030
CD19⁺/L	He^［16］	155 (105~229)	190 (139~268)	91 (54~139)	＜0.001
	Kong^［20］	100(100~200)	100(100~200)	100(50~100)	0.082
CD16⁺CD56⁺/L	He^［16］	127 (81~209)	144 (93~231)	105 (66~168)	＜0.001
	Kong^［20］	100(100~200)	200(100~300)	100(100~200)	0.074

图3 轻症和重症COVID-19患者淋巴亚群降低百分比

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The role of lymphocyte indicators in the diagnosis and treatment of COVID-19

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The role of lymphocyte indicators in the diagnosis and treatment of COVID-19